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Xiidra
Horizon Blue Cross and Blue Shield of New Jersey
Horizon Blue Cross and Blue Shield of New Jersey Coverage for Xiidra
All
7
Commercial
4
Health Exchange
1
Medicare
2
Commercial
Commercial - HMO
PA Required
No Step Therapy
Quantity Limit
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Commercial - PPO
PA Required
No Step Therapy
Quantity Limit
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Commercial - Point of Service
PA Required
No Step Therapy
Quantity Limit
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Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
PA Required
No Step Therapy
Quantity Limit
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Medicare - Prescription Drug Plan
PA Required
No Step Therapy
Quantity Limit
See Details
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